Outcomes for endoscopic submucosal dissection of pathologically staged T1b esophageal cancer: a multicenter study

doi:10.1016/j.gie.2022.02.018

Gastrointestinal Endoscopy

Volume 96, Issue 3, September 2022, Pages 445-453

https://doi.org/10.1016/j.gie.2022.02.018 Get rights and content

Background and Aims

The outcomes of endoscopic submucosal dissection (ESD) for T1b esophageal cancer (EC) and its recurrence rates remain unclear in the West. Using a multicenter cohort, we evaluated technical outcomes and recurrence rates of ESD in the treatment of pathologically staged T1b EC.

Methods

We included patients who underwent ESD of T1b EC at 7 academic tertiary referral centers in the United States (n = 6) and Brazil (n = 1). We analyzed demographic, procedural, and histopathologic characteristics and follow-up data. Time-to-event analysis was performed to evaluate recurrence rates.

Results

Sixty-six patients with pathologically staged T1b EC after ESD were included in the study. A preprocedure staging EUS was available in 54 patients and was Tis/T1a in 27 patients (50%) and T1b in 27 patients (50%). En-bloc resection rate was 92.4% (61/66) and R0 resection rate was 54.5% (36/66). Forty-nine of 66 patients (74.2%) did not undergo surgery immediately after resection and went on to surveillance. Ten patients had ESD resection within the curative criteria, and no recurrences were seen in a 13-month (range, 3-18.5) follow-up period in these patients. Ten of 39 patients (25.6%) with noncurative resections had residual/recurrent disease. Of the 10 patients with noncurative resection, local recurrence alone was seen in 5 patients (12.8%) and metastatic recurrence in 5 patients (12.8%). On univariate analysis, R1 resection had a higher risk of recurrent disease (hazard ratio, 6.25; 95% confidence interval, 1.29-30.36; P = .023).

Conclusions

EUS staging of T1b EC has poor accuracy, and a staging ESD should be considered in these patients. ESD R0 resection rates were low in T1b EC, and R1 resection was associated with recurrent disease. Patients with noncurative ESD resection of T1b EC who cannot undergo surgery should be surveyed closely, because recurrent disease was seen in 25% of these patients.

Section snippets

Methods

This was a retrospective cohort study of patients who underwent ESD for pathologically confirmed T1b EC at 7 academic tertiary referral centers in the United States (n = 6) and Brazil (n = 1) between January 1, 2013 and June 1, 2021. Institutional review board approval from each participating center was obtained. Information was gathered from prospectively managed databases at each institution. Study data were collected and managed using REDCap electronic data capture system hosted at the

Patient and procedure characteristics

Sixty-six patients underwent ESD for pathologically staged T1b EC. Patient demographics and lesion characteristics are presented in Table 1. The number of procedures from each center was as follows: Cleveland Clinic, 19; University of Florida, 13; University of Sao Paulo, 11; Brigham and Women’s Hospital, 7; Mayo Clinic Arizona, 8; Parkview Cancer Center, 5; and University Hospitals, 3.

Seventy-four percent of patients (49/66) had EAC and 25.8% (17/49) had ESCC. Twenty-one percent of patients

Discussion

The main finding of our study was that the R0 resection rate for ESD of T1b EC was lower (54.5%) than that reported in contemporary series of ESD for T1a EC. We found that R1 resection of T1b EC was associated with residual/recurrent disease (hazard ratio, 6.25; 95% confidence interval, 1.29-30.36; P = .023). In our series, no local or metastatic recurrence occurred after ESD resection of T1b EAC within the curative criteria. In patients with noncurative resection of T1b EC, irrespective of

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: DISCLOSURE: The following authors disclosed financial relationships: P.V. Draganov: Consultant for Boston Scientific, Lumendi, Cook, Olympus, and Microtech. F. Maluf-Filho: Consultant for Boston Scientific, Cook, and Olympus America. H. Aihara: Consultant for Olympus America, Boston Scientific, Fujifilm Medical Systems, Medtronic, ConMed, and 3-D Matrix. N. Fukami, J. Vargo: Consultant for Boston Scientific and Olympus America; Advisory Board for DocBot and Aspero Medical; research funding from Olympus America, Inc. N. R. Sharma: Consultant for Boston Scientific, MedTronic, Mauna Kea Technologies, Steris, Merck, and Shark, & Dohme Corporation. A. Chak: Consultant for US Endoscopyand MicroTek Diagnostics; advisor for CDX Diagnostics; investment interest in Lucid Diagnostics. D. Yang: Consultant for Boston Scientific, Lumendi, and Steris. J. Dumot: Consultant for US Endoscopy. X. Zhang: Consultant for Merck Sharp & Dohme Corporation. S. Kamath: Consultant for Exelixis Inc and Tempus. A. Bhatt: Consultant for Boston Scientific, Lumendi, Medtronic, and Olympus; royalties from Medtronic. S. Jang: Consultant for Boston Scientific and Steris. S. Jawaid: Consultant for ConMed and Lumendi. S. Murthy: Consultant/board member for Advanced Medical Solutions, LLC All other authors disclosed no financial relationships.

: See CME section, p. 563.

: If you would like to chat with an author of this article, you may contact Dr Bhatt at [email protected].

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Original articleClinical endoscopyOutcomes for endoscopic submucosal dissection of pathologically staged T1b esophageal cancer: a multicenter study

Background and Aims

Methods

Results

Conclusions

Section snippets

Methods

Patient and procedure characteristics

Discussion

Gastroenterology

Gastroenterology

J Biomed Inform

J Biomed Inform

VideoGIE

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Gastrointest Endosc

Matrix Biol

Ann Thorac Surg

Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries

CA Cancer J Clin

Cancer statistics, 2021

CA Cancer J Clin

The Society of Thoracic Surgeons Composite Score for Evaluating Esophagectomy for Esophageal Cancer

Ann Thorac Surg

Trends in the incidence and survival of patients with esophageal cancer: a SEER database analysis

Thorac Cancer

Long-term efficacy and safety of endoscopic resection for patients with mucosal adenocarcinoma of the esophagus

Gastroenterology

The prevalence of lymph node metastases in patients with T1 esophageal adenocarcinoma a retrospective review of esophagectomy specimens

Ann Surg

Endoscopic management of Barrett's esophagus: European Society of Gastrointestinal Endoscopy (ESGE) position statement

Endoscopy

Original article
Clinical endoscopy
Outcomes for endoscopic submucosal dissection of pathologically staged T1b esophageal cancer: a multicenter study